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Bone marrow iron stain

Hematology · also called Perls' Prussian blue stain, Marrow iron stores, Sideroblast count

What it measures

A Prussian blue stain of a bone marrow aspirate showing stored iron in macrophages and iron granules in developing red cells. It remains the reference test for body iron stores and for ring sideroblasts.

Specimen and preparation

Specimen: Bone marrow aspirate smear (particle-rich) or trephine
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Preparation: Requires a bone marrow procedure by a trained clinician; include marrow particles on the slide.

Reference range

Group	Range
Storage iron	Present (grade 2+ to 3+)
Sideroblasts	20–50% of erythroblasts; no ring forms

Reference ranges differ between laboratories, methods and populations. Always use the range printed on your own lab report.

Causes of high values

Anemia of chronic disease (iron trapped in macrophages)
Iron overload (hemochromatosis, repeated transfusion)
Sideroblastic anemia and MDS (ring sideroblasts)

Causes of low values

Absent iron: iron deficiency anemia
Low sideroblasts: anemia of chronic disease

Method

Perls' Prussian blue reaction with light microscopy; graded 0 to 6+

Good to know

Ring sideroblasts are defined as five or more granules around at least one-third of the nucleus. Decalcified trephines underestimate iron.

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